Killing or caring?BMJ 2005; 330 doi: https://doi.org/10.1136/bmj.330.7491.560 (Published 10 March 2005) Cite this as: BMJ 2005;330:560
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Recently Verhagen and Sauer described euthanasia as a measure against neonatal suffering (1,2) due to some causes, among which they cite a bad prognosis or the possibility of a low quality of life. But newborns don’t suffer for these reasons. Suffering is the gap between what we expect from life and what we actually get (2), and newborns suffer from insulation and from endless painful procedures; but they cannot suffer from having no chance of survival or a poor prognosis as they have no self-awareness; and the struggle against pain has been won by good analgesic drugs. Moreover, in the future they may become so neurologically impaired that their self-awareness will almost be non existent, and also in this case the word suffering is a misnomer. We have good analgesic drugs and only a bad treatment of pain provokes suffering; moreover, a bad prognosis is not a reason for suffering if the subject cannot be aware of it. Neonatal euthanasia does not cure newborns’ suffering. Does it cure ours?
1. Verhagen E, Sauer PJJ: The Groningen Protocol — Euthanasia in Severely Ill Newborns. N Engl J Med 2005 352:959-962
2. Sheldon T: Killing or caring? BMJ 2005;330(7491):560
3. Schopenhauer A: On the basis of morality, trans. Payne EFJ. Indianapolis: Bobbs-Merrill, 1965:196
Competing interests: None declared
Competing interests: No competing interests
I was appalled by the comments of Dr Verhagen and my distress is on several levels.
His comment, “If palliative care is not an option, what do I do?” really frightens me. I am sure that palliative care specialists would be deeply concerned that he would not offer some sort of supportive therapy. One cited example in the interview is epidermolysis bullosa, which can be a horrific condition. I am sure many palliative care experts could suggest appropriate pain and sedation protocols to ensure that any patient is kept comfortable.
Numerous conditions are currently managed with what is effectively long-term palliation, as there is no cure. These would include cystic fibrosis, hypoplastic left heart syndrome, diabetes and human immunodeficiency virus infection. Therefore, all these conditions are hopeless, being associated with a shortened lifespan and multiple hospital admissions. However, with the advances in medical, transplant and gene therapy the future holds the possibility of cures. Therefore, continuing to extend patients lives seems justified.
So what of the example of epidermolysis bullosa? If at some point an effective therapy or cure turns the most extreme forms of this into a manageable condition, how will the parents of the killed baby feel? Especially, if the therapy becomes available within the expected life expectancy of the killed child. Would then the doctor be prosecuted, or sued? Or is epidermolysis bullosa like cystic fibrosis, which traditionally led to death within the first year of life many years ago, but ongoing refinements in management have led to steadily lengthening of the life expectancy? If Dr Verhagen had been a doctor when cystic fibrosis was a hopeless disease associated with unbearable suffering I presume he would have been happy for it to remain untreated now.
Another problem I have is with the language used. The concepts of “pointless” or “hopeless” are very difficult. They depend far too heavily on the passage of time, as from a logical perspective all life is hopeless; we all seem to die eventually. Pointlessness is also an appropriate description of existence, purposefully ignoring religious interpretations of life. In the life of the multiverse what does one life matter, or indeed all life? On a human level there seems an obvious difference between a life span of 2 days and 70 years, but what of the difference between 2 days and 2 years, or even 2 years and 70 years. Therefore, selecting who should be terminated is fraught with difficultly. So much so that the Netherlands abolished the death penalty in 1870. I am not sure that, as a doctor, I have the wisdom, training, or arrogance to make a decision of this nature.
Competing interests: I am a consultant in neonatal meidicne
Competing interests: No competing interests